Category Archives: Education

Spiritual Advance Directive

 

Every adult needs to complete an advance directive (and that means you, too!). It is the health care planning document that medical professionals follow if a patient becomes too ill to speak for him or herself. It gives your loved one the option to name someone as decision maker. And it is the place he or she can state preferences regarding life-sustaining treatment.

More than medicine

Death and dying is more than a medical event, however. Like birth, a family member’s death is a profound part of a family’s life journey. Just as an expectant mom might contemplate where to give birth and the emotional tone of the environment, your loved one may have thoughts about where to die and those surroundings. This may involve his or her religious or spiritual beliefs and preferences. Or may simply reflect personal rituals and symbols. The advance directive is a vehicle for your relative to describe these wishes, but you might need to start the conversation.

Some questions you might ask:

  • Is there anything you would like us to do that is rooted in your faith? Tell us everything you can about what you might like. Any faith leader you would like us to call?
  • Where would you prefer to pass? At home? Somewhere else?
  • How do you envision the room? Special photos or prayers? Poems or music?
  • To provide a sense of who you are, how shall we describe you to the doctors, nurses, or other helpers who may not have met you before? “Above all, he/she was a person who _____.”

A final gift

Capture your relative’s wishes on paper. Have him or her sign the document and attach it to the advance directive. Knowing your loved one’s spiritual wishes enables you to give him or her a final gift of comfort and dignity.

Is this an uncomfortable topic?

We at Senior Life Management understand this is not always an easy discussion. As the Orange County experts in family caregiving, we can help you and your loved one get started on an advance directive and even explore these more personal, very meaningful aspects—”spiritual planning.” Give us a call at 949-716-1266.

When the worrying won’t stop

 

Worry is useful when it calls us to action. But it’s a problem when it becomes an ongoing state of mind. It can become a habit, bringing tension and stress.

If you’re a worrier, you may have mixed feelings. It may seem that worry

  • keeps you on your toes, yet it
  • makes you edgy and distracted, interfering with your sleep and peace of mind.

Relieving the stress of worry doesn’t mean you have to stop worrying. Here are some strategies to harness the positives of worry and keep the rest in balance:

  • Don’t try to give it up. Instead, do it consciously and take notes! Schedule a 45-minute “worry time” for yourself every day. If a worry pops up at another time, write it down for review during your next worry period.
  • Clarify what is fact and what is emotion. Hint: Facts are in the present tense. (“Dad seems tired and is coughing a lot.”) Emotional concerns often have a “future” component involving a problem that might happen (“What if it’s lung cancer?”).
  • Create a strategy for action. Unproductive fears are usually based in uncertainty. Create a list of action steps to answer the unknowns. (“Look up the symptoms of lung cancer. Find out how many risk factors he has. Make an appointment with the doctor.”)
  • Write out a balanced perspective. While completing the action steps, your mind is unlikely to just “let go” of the worries. For each worry, write down evidence in its support and evidence against it. For instance, “Dad spent the afternoon in bed today. Then again, just last week he played a full round of golf with his buddies, and no coughing.” When the worry reappears, you can respond to it with this alternative, fact-based thought.

Seek professional help if your worrying feels unmanageable.

Want help with the source of your worries?

You may be worried because there is simply more to do than you can handle by yourself. Or you don’t know the spectrum of normal aging, so you don’t know whether a situation is dire or not. You don’t need to do this alone. As the Orange County experts in family caregiving, we at Senior Life Management can provide that perspective. Give us a call at 949-716-1266.

Managing Chronic Pain

“Chronic pain” is pain that lasts for 12 weeks or more. The cause is usually nervous system misfiring, like a faulty car alarm system. Often there is no specific trigger, which makes treatment difficult.

Chronic pain is common, affecting 50%–66% of adults age 50 and older. Opioid drugs are recommended for pain control in life-threatening illnesses such as cancer. For those with chronic pain, however, a mix of pain relief strategies is better.

With chronic pain, a full recovery to “no pain” may not be realistic. Instead, it’s a matter of finding ways to help your loved one adjust so he or she can continue activities that bring meaning to life despite the pain.

Pain is physical, and the experience of pain can be reduced with physical changes. Pain is also highly affected by mental perception. In other words, how negatively we think about it. These two qualities open the door for many nondrug strategies of pain management. For instance:

  • Physical therapy. Exercises to gain strength and flexibility can improve overall comfort.
  • Occupational therapy. Learning new ways to accomplish daily tasks may reduce pain.
  • Exercise. Low-impact physical activity—walking, swimming—releases endorphins, the body’s natural pain killer.
  • Quality sleep. Lack of sleep makes pain worse. Good rest supports resilient coping with pain.
  • Relaxation techniques. Special techniques can train the mind and body to interrupt the pain cycle (in which pain triggers fear and tension, which brings more pain).
  • Meditation. Mindfulness practice can help your loved cope by “seeing” the pain from a new perspective.
  • Counseling. Counseling can help your relative identify and change the thoughts, feelings, and actions that amplify pain. Cognitive behavioral therapy is often the most helpful. It can also address depression and anxiety, which then lowers pain.

Looking for pain management strategies?

Of course the first step is to talk with a doctor to get a diagnosis and find out about nonnarcotic, nonaddictive sources of relief. At Senior Life Management we have seen that a combination of therapies works best. As the Orange County experts in family caregiving, we know how difficult it is to care for a loved one in pain. We also understand your concerns about opioids and other drugs. Give us a call at 949-716-1266. You don’t have to navigate this alone.

Researching Treatments Online

For those facing a serious—or even incurable—condition, the Internet can seem to be the last refuge of hope. But how can you distinguish a trustworthy website from that of a huckster? “Follow the money” is an important key for deciding if a website is truly unbiased. Start by asking yourself who, what, and why.

Who: Whose site is it? Websites cost money to create. Who is paying? Check the “About Us” page. If the source of money is not obvious, use “Contact Us” to ask, “Who are you and how do you get your funding?” Keep that funding in mind as a possible source of bias.

What: What kind of information is provided?

  • Is it a research-based news article? Does it cite research done in university or government studies? Is there mention of “randomized clinical trials”? These are the gold standard of science.
  • Is it a blog? Is it one person’s opinion, or are other sources included? What are the author’s credentials? Are they reliable?
  • Is it a forum (or “chat room”)? Anyone can speak in a forum. Chat rooms offer a wealth of practical tips for day-to-day coping with side effects. But they are not reliable sources for evaluating the success rate of treatments.
  • Is it really just a sales piece? Does it make claims about a treatment sold by the sponsor? If so, review multiple sources and look for promises that are backed by credible research as described above.

Why: Does the website identify its purpose? Government and university websites typically have a mission to educate. The websites of nonprofit organizations usually weave education with advocacy. A for-profit company is not automatically suspect. Many generously share their expertise through educational articles. Simply use caution if they ask for your personal information or if the talk turns to specific treatments that they themselves sell.

Confused about where to turn?

As the Orange County experts in family caregiving, we at Senior Life Management can help you determine your confidence level in the various options you are considering. Give us a call at 949-716-1266.

Conserving Energy in the Face of Fatigue

Conserving Energy

People with congestive heart failure (CHF) often tire easily, especially if they exert themselves. In CHF, the heart is swollen with fluids and cannot beat efficiently. The body’s cells then become hungry for oxygen. If your loved one has CHF, you witness this in his or her fatigue, shortness of breath, and frequent naps.

Even with CHF, however, your relative needs to be physically active. Physical activity helps the heart muscle gain strength. It improves circulation. It helps with weight control, and, oddly, with reducing fatigue. Exercise also helps with depression, which is common in CHF.

Pacing is the key. Talk with the doctor about optimal forms of physical activity. Initially, walking, swimming, or biking may be recommended. As CHF progresses, simple tasks, such as taking a shower or cooking a meal, may qualify as exercise. Ask the doctor for a prescription to work with a cardiac rehab team to create an activity plan tailored to your loved one’s needs.

Conserving energy. Think of personal energy as a tank of gas. With CHF, your relative has a small tank and needs to be “fuel efficient.” Conserving energy when doing chores leaves more “in the tank” for doing things that bring joy and meaning.

  • Alternate periods of activity with periods of rest. Divide large chores into smaller tasks throughout the day or across the week.
  • Avoid rushing. It wastes energy.
  • Work smarter. Minimize trips up or down stairs. Cook large quantities of food and freeze for heating later. Instead of towel drying, slip on a terry cloth bathrobe after bathing.
  • Get help for mundane tasks. Have groceries and prescriptions delivered.
  • Create workstations that permit cooking, grooming, dressing, bathing while seated.
  • Use a cart or walker with a basket for carrying things from place to place.
  • Avoid bending or reaching. Use extenders.

Looking for ways to ease fatigue?

Give us a call at 949-716-1266. As the Orange County experts in aging well, we at Senior Life Management understand that quality of life is based on how much time your loved one can spend doing things he or she truly enjoys. Let us help you identify ways to conserve on chores so your relative can go full throttle on pleasant activities.

Bathing and Dementia

bathing discomfort

Bathing brings many discomforts. Bathrooms can feel cold and drafty when a person is wet. And running water can be noisy. Nudity makes bathing very intimate, which can be distressing when a modest person needs help and may not recognize the helper.

Plus, bathing is a complicated process with many steps in a specific order. People with dementia may become confused and frustrated. They also may forget about the purpose of cleanliness.

Here are some tips to ease bath time:

  • Guard the senses. Sometimes people with dementia are hypersensitive. Heat the bathroom ahead of time. Be gentle and avoid scrubbing. Check the water for temperature—too hot?—and the water pressure from the shower—too hard?
  • Promote independence. Encourage your loved one to do things themselves. If you do need to take over, tell them what you are going to do before you do it. And give them a role so they can participate, such as holding the soap.
  • Preserve modesty. Even if you are helping a spouse, have a towel at the ready for undressing and dressing.
  • Maintain a routine. Most families notice that certain times of day are better than others. Bathing at the same time each day may make it easier.

Sponge baths work just as well. In terms of hygiene, all that’s needed is a twice a week wash, and even that can be just the highlights: armpits, folds of skin (under the breast, on the belly), groin, genitals, feet. Remember to keep the rest of the body covered with warm towels to minimize any chill.

Get creative

  • Try singing together. Or play music or old radio shows for distraction.
  • Consider using bath wipes. Warm by putting an open package in the microwave for 10 seconds. Find out How to keep the bathroom dry.
  • Call it “spa time.” Use no-rinse soap on moist, warm midsize towels and massage in gently. Wipe off with warm, moist washcloths.

Tired of the bathroom battlefield?

As the Orange County experts in family caregiving, we at Senior Life Management have developed many strategies and insights that can help you make bath time more pleasant. Make a vote for peace in the household and give us a call at 949-716-1266.

Signature Strength: Calm

Signature Strength

Many of us admire people who have the gift of remaining calm. Calm as a signature strength is the ability to respond to threats from a place of appropriate confidence. To remain “centered.”

It’s not always easy to achieve. Our bodies react to the stresses of modern life—including family caregiving—with the same fight-or-flight hormones that saved us in more physically dangerous times.

That said, you can intentionally cultivate the skills involved in remaining calm. People who are calm

  • have the ability to physically relax. You might use strategies such as focused breathing. Perhaps a mindfulness practice. Or activities that release tension.
  • accurately assess threats. It’s easy to overestimate the negative. Or get stuck thinking about “what ifs.” Calm individuals notice threats, yet keep them in perspective. Here’s where you want to apply a healthy dose of reality. Assess a problem situation. Yes, do look at the worst-case scenario. But remember to consider the likelihood of that extreme. Calm individuals spend most of their time focusing on the more probable outcomes in between chaos and serenity.
  • observe the situation with an awareness of their strengths. Calm individuals have self-confidence. They have an accurate and balanced assessment of their personal strengths. To develop this, take an accounting of your internal gifts. Also identify the external supports you have. For instance, your finances, friends, support services.
  • reduce anger. Anger clouds rational thought. It’s not that calm individuals do not get angry. They simply recognize their triggers. And they use strategies to calm themselves effectively before they blow. You might start by watching your thoughts. Avoiding judgment and fault finding in others may help you stay at ease.

As you look to become a more resilient family caregiver, you may find that cultivating the strategies of calm individuals helps keep your own journey centered.

Does calm feel far away?

As the Orange County experts in family caregiving, we at Senior Life Management understand how stressful it can be to care for a relative in need. It helps to talk with someone outside the situation to get a clearer picture of the threats, as well as your genuine resources, to develop the confidence needed to remain calm. Give us a call at 949-716-1266. You don’t need to do this alone.

Preparing for a Safe Return

Alzheimer's Association

No one can keep an eye on another person 24/7. Even in the most vigilant household, a loved one with dementia—Alzheimer‘s or other memory disorder—may just find a way to slip out the door. After you have set up strategies to reduce the chance of wandering, it is also wise to pave the way for a speedier recovery if the worst occurs.

Strategies that support a quick return

  • Get an ID bracelet or necklace. Be sure to note “Memory Loss” and “ICE: [your phone number].” First responders know that “ICE” stands for “in case of emergency.”
  • Introduce your loved one to neighbors. Give the neighbors your phone number and ask them to call you if they see your relative out and about. You can even ask local merchants who know him or her to do the same.
  • Keep a recent photo on hand. Only a recent photo—not a favorite photo from 10 years ago!—will truly help first responders if they must look for your family member.
  • Make a list of possible destinations. Include your relative’s favorite places. But also list familiar places from the past: work, church, a previous residence.
  • Add GPS sensors on shoes or in a bracelet. These sensors can trigger an alarm on a door and/or help locate someone who has wandered. Some require a monthly fee.
  • Register with the local police and consider a Safe Return type of program. The Alzheimer’s Association sponsors a nationwide “Safe Return” program that is networked with local law enforcement. If your family member wanders, one call triggers an alert for help. A special bracelet also provides anyone finding your relative a number to call.

If your loved one does get out, spend 15 minutes looking close by. Then call 911 and any other services you have in place.

Does the chance of wandering scare you?

If you are concerned, give us a call at 949-716-1266. At Senior Life Management we understand the anxiety that wandering presents. How it can impair your sleep and make for very stressful days. As the Orange County experts in family caregiving, we can help you make arrangements at home that discourage wandering. We can also help you make preparations for a speedy recovery. You don’t have to do this alone.

 

2019 Medicare Improvements

Medicare Advantage

Here’s some good news to start the year! In 2019, we’ll see improvements in coverage across the major Medicare plans.

About two-thirds of people on Medicare use “original Medicare.” Patients with original Medicare can go to any health care provider that accepts Medicare. Original Medicare pays for 80% of costs after a yearly deductible. The remaining 20% is paid out of pocket. In addition, your loved one may have a supplemental insurance. Sometimes this is called “Medi-Gap.” Medi-Gap policies pay the deductible and that 20%.

There is also a “Medicare Advantage” plan. If your family member has this coverage, he or she must go to providers who are part of the plan’s network. Medicare Advantage programs usually cost less than a combined original Medicare and Medi-Gap policy.

Starting in 2019

“Donut hole” is closing early

Medicare Part D has been paying roughly 75% of medication costs up to a set amount per year. Patients paid the balance of 25%. If costs were higher, the patient had to pay a greater percentage out of pocket (35-44%). If your relative’s drug costs reached a second threshold, additional medicines were then covered 95% by Medicare, 5% by the patient. In 2019, that “donut hole” gap in coverage is “closing,” meaning it is getting smaller. And a year earlier than planned. This year Medicare will extend coverage of brand name drugs at 75% up to the second threshold. Then 95% coverage will kick in. Generics will have a 63% coverage rate after the first threshold. The following year, generics will be covered at the 75% rate as well.

Nonmedical support services

Some Medicare Advantage Plans have been given permission to expand coverage beyond traditional medical care. With a doctor’s orders, for instance, they have the option to offer policies that provide for things like the installation of grab bars or a wheelchair ramp. Check your loved one’s plan to see if it includes this type of coverage.

Want to switch policies?

Wish your loved one had a different plan? As of 2019, those with an existing Medicare Advantage plan may switch to a different plan within the first three months.

Do you find Medicare confusing?

You aren’t alone! As the Orange County experts in family caregiving, we at Senior Life Management can help you decide if there’s a plan that would be better. Give us a call at 949-716-1266.

 

 

Gifts for Older Adults

gifts

What to get for the “chronologically gifted?” The age-friendly ideas below address the special interests or concerns of persons in their later years.

Providing an experience. Don’t add to household clutter—give an activity! This way, you give the fun of anticipation as well as countless hours of enjoyment afterwards, remembering. Ideally, arrange the gift as something your loved one can do with someone—you or a friend. After all, “a joy shared is twice a joy.”

  • A gift card for a favorite restaurant.
  • A book of movie passes.
  • Tickets to a theater or musical performance.

Supporting connection. If your family member has been outrun by the pace of technology, a simple device might be fun. But only if you can be the tech advisor to set it up and maintain it! Or can provide for in-person tech help as part of the gift. Consider:

  • Fax-to-email converters. Your relative can write a note and put it in the machine to be emailed out to others. Conversely, a converter fax can receive emails to print out on paper. No computer or Internet required!
  • Simplified phones and tablets. These come with a special interface that has large buttons and limited options. Without the whiz-bang features older adults don’t need, these devices let non-techies enjoy the connective opportunities of the Internet.

Honoring cherished memories. Over time, your loved one has doubtless accumulated many fond memories of people and events. Reminiscing is fun, even if your relative has memory problems. Help your loved one savor recollections of beloved people and experiences with:

  • A puzzle made from family photos. Another, similar option is to have a blanket printed with photos of your choosing.
  • A digital photo frame. Connect a “smart frame” to Wi-Fi and you can even upload new pictures remotely. (Again, be sure to include tech assistance as part of the gift!)

Looking for distinctly practical gifts?

Perhaps your loved one needs help getting around. Or he or she may need a grab bar or other safety device. If you are concerned, give us a call at 949-716-1266. As the Orange County experts in family caregiving, we at Senior Life Management can do an assessment to give you a sense of the most appropriate device or services.

Stress or Burnout?

burnout

 

Most of us know it when we’re stressed. We talk about it, and we talk about needing to do something about it…when we have the time.

But we might not be aware when we reach the point of burnout. That’s because going numb is the nature of burnout. To be so worn out that you are beyond caring.

Put simply, burnout is stress that has gone on too long. It is an important distinction to understand. Burnout has more serious, long-term consequences for your physical health and for your emotional well-being.

Take a moment for self-reflection and assess yourself.

If you are stressed, you are

  • constantly on the go, urgently trying to get things done.
  • emotionally brittle, tending toward irritability and anxiety. Your thinking might be a bit scattered.
  • tired and not sleeping well, rushing through leisure activities.

If you are a stressed family caregiver, you are scrambling to keep up with the demands of your role. But you believe that you eventually can get everything under control, and doing so feels important to you. Getting stress relief is a goal.

If you are burned out, you are

  • doing less and less and still feeling exhausted.
  • emotionally dull and hopeless, feeling there’s no point in making an effort at anything because nothing ever changes.
  • frequently physically ill, catching every cold that comes around.
  • withdrawing from friends and activities and often overconsuming food, alcohol, tobacco, etc.

To put this in perspective, consider stress to be a blinking yellow light: Yield. Slow down. Find a way to weave in more breaks. Consider burnout to be a red light: Stop. You have given too much for too long. Change is needed immediately before burnout undermines your health and your ability to provide appropriate care for your loved one.

Do you recognize the signs of burnout?

At Senior Life Management we see dedicated family members who, frankly, are fried! They are beyond stress and are dangerously in the realm of burnout. As the Orange County experts in family caregiving, we know it doesn’t have to be this hard. There are options. Give us a call and let’s start the conversation: 949-716-1266.

Exercise and COPD: an oxymoron?

COPD

Does Mom say she feels too weak to exercise? Does Dad run out of breath just walking down the street? People dealing with COPD often believe that exercise will make things worse. Actually, in moderation, quite the opposite is true.

Very real benefits. Even people with severe COPD can become more physical. Something as simple as arm lifts or singing can improve breathing and reduce fatigue. Exercise also helps with the fuzzy thinking many older adults experience with their COPD—because it gets more oxygen to the brain. Plus, people who engage in physical activity even just three times a week have been able to reduce the severity of COPD flares. If they have to be hospitalized, they get home sooner. Best of all, it’s not that hard to achieve these improvements.

Talk with the doctor first. Don’t challenge your loved one to a mile starting out! A balanced approach is required with COPD. The goal is to stretch breathing capability and stamina a little bit at a time without getting overly tired. Your family member’s doctor can give guidelines about when to stop and when to push past that initial feeling of “today is not a good day.”

Ask for pulmonary rehabilitation. The doctor may be able to prescribe a special exercise class for people with COPD. Exercising under supervision supports your loved one to feel safe. A class also presents the chance to talk with others who face the same challenges, which helps combat the isolation and depression that are common with COPD.

Tips for making it easier. Have your loved one

  • pick an activity that is pleasurable;
  • start small and increase gradually;
  • find an exercise buddy. This adds fun and supports commitment;
  • ask to be trained on “pursed lips breathing.” This technique makes it easier to exhale deeply and bring in enough oxygen.

Does better breathing feel impossible?

At Senior Life Management we have seen how people with COPD who didn’t think they could exercise can actually improve their breathing with very light, supervised activities. Even a physical therapist coming to the home a few times can guide your relative to exercises that will reduce that scary feeling of air hunger. Give us a call at 949-716-1266. As the Orange County experts in family caregiving, we can help you get the support needed to make each day the best it can be.

Savoring Good Experiences

positive experiences

Sharing positive experiences is like sharing a good meal, warms and strengthens friendships and family bonds. There are other benefits to savoring positive experiences. Even in the privacy of your own thoughts, reflecting on pleasant memories is an easy and effective way to increase your overall happiness.

Hard wired to focus on the negative

Have you noticed that even a small negative event can grab your attention repeatedly over the day? Positive events, by contrast, rarely come back to mind. That’s human. Our brains are hard wired to pay attention to threats.

Retraining our brains

As a family caregiver, you may find yourself focused on the things that aren’t going well. This zaps your energy. It also sets you up for depression, a common occurrence when caregiving. Fortunately, as humans we can retrain our brains to notice the positive for a more-balanced assessment of our days.

Try this exercise

  • Before bed, write down three good things that happened over the day. They don’t have to be big events. Just things that felt positive. Maybe a good conversation or a leisurely walk. Include as much detail as you can.
  • For each one, also write down “why” it was positive. Knowing what uplifts you tunes you into future opportunities for positive activities.
  • Take 30 seconds to relive or savor each memory. Close your eyes. Were there particular smells at the time? Sounds? Thoughts? Immerse yourself in the full memory of the event.
  • If possible, tell others about the event over the next few days. The recounting of it helps seal it in your awareness.

Why it works

Neurons that fire together wire together.” The more memory traces you create of positive experiences, the more adept your brain will become at recognizing the positives. You won’t lose your ability to identify threats. But you will form more-accurate assessments of your life and increase your overall sense of happiness.

Does the positive elude you?

If finding the positive experiences is difficult, it may be a sign that you could use some caregiving help. As the Orange County experts in family caregiving, we at Senior Life Managementunderstand that it’s a lot to shoulder. Give us a call at 949-716-1266. Let’s talk and see what we can do together to bring more positives to your day.